Life & Health Insurance Exam Claims and Benefits 2

Question 1

Under the 'proof of loss' provision, how many days does a health insured typically have to submit proof of loss after a claim?

Accepted Answer

90 days

Answer

Most health insurance policies require the insured to submit written proof of loss within 90 days of the loss.

Question 2

A life insurer discovers that an insured misrepresented their age on the application. What will the insurer most likely do?

Accepted Answer

Adjust the benefit to what the correct premium would have purchased

Answer

When age is misstated, insurers adjust the death benefit to the amount the actual premium would have purchased at the correct age rather than voiding the policy.

Question 3

Which type of health insurance claim is filed directly by the provider to the insurer on behalf of the patient?

Accepted Answer

Assignment of benefits claim

Answer

When a patient assigns benefits to the provider, the provider submits the claim and receives payment directly from the insurer.

Question 4

What is 'subrogation' in the context of health insurance?

Accepted Answer

The insurer's right to recover claim payments from a liable third party

Answer

Subrogation allows the insurer to recover amounts paid on a claim from a third party who was legally responsible for the loss.

Question 5

A disability income policy's 'elimination period' functions most like which feature of other insurance policies?

Accepted Answer

Deductible

Answer

The elimination period is a waiting period before benefits begin, functionally similar to a time-based deductible.

Life & Health Insurance Exam Practice Test

Life & Health Insurance Exam Practice Test

Life & Health Insurance Exam Claims and Benefits 2